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Nitric oxide evaluation in upper and lower respiratory tracts in nasal polyposis
Author(s) -
Delclaux C.,
Malinvaud D.,
ChevalierBidaud B.,
Callens E.,
Mahut B.,
Bonfils P.
Publication year - 2008
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/j.1365-2222.2008.03006.x
Subject(s) - medicine , exhaled nitric oxide , spirometry , interquartile range , respiratory tract , methacholine , asthma , respiratory system , pulmonary function testing , plethysmograph , gastroenterology , anesthesia , respiratory disease , lung
Summary Background A decrease in nasal nitric oxide (NO) and an increase in exhaled NO have been demonstrated in patients with nasal polyposis (NP). Objectives The aims were to evaluate the flux of NO from the three compartments of the respiratory tract, namely, upper nasal, lower conducting and distal airways, and to search for relationships between NO parameters and indexes of upper and lower disease activity (bronchial reactivity and obstruction). The effect of medical treatment of polyposis was also evaluated. Methods Seventy patients with polyposis were recruited. At baseline, pulmonary function tests (spirometry, plethysmography, bronchomotor response to deep inspiration using forced oscillation measurement of resistance of respiratory system, methacholine challenge, multiple flow rates of exhaled NO and nasal NO measurements) were performed together with an assessment of polyposis [clinical, endoscopic and computed tomography (CT) scores]. Results Statistical relationships were demonstrated between nasal NO flux and severity scores (clinical: ρ=−0.31, P =0.015; endoscopic: ρ=−0.57, P <0.0001; CT: ρ=−0.46, P =0.0005), and between alveolar NO concentration and distal airflow limitation (FEF 25–75 , ρ=−0.32, P =0.011). Thirty‐six patients were assessed after 11 [7–13] (median [interquartile]) months of medical treatment, demonstrating an improvement in clinical and endoscopic scores, an increase in nasal NO flux, a decrease in NO flux from conducting airways, an improvement in the mild airflow limitation (forced expiratory volume in 1 s, FEF 25–75 , even in non‐asthmatic patients) and a decrease in the bronchoconstrictor effect of deep inspiration. Conclusions The medical treatment of NP improves both airway reactivity and obstruction, whatever the presence of asthma, suggesting a functional link between upper and lower airway functions.